| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,536 |
1,528 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,397 |
2,211 |
$34K |
| D1120 |
Prophylaxis - child |
798 |
795 |
$28K |
| D0274 |
Bitewings - four radiographic images |
792 |
789 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,423 |
1,421 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
307 |
306 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
327 |
$15K |
| D0350 |
|
1,410 |
836 |
$13K |
| D1110 |
Prophylaxis - adult |
104 |
104 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
94 |
$8K |
| D4910 |
|
36 |
36 |
$3K |
| D9430 |
|
31 |
30 |
$840.00 |